Summary
It's yet another of hospitals' well kept secrets (until recently). Many of them have high readmission rates especially for patients with conditions such as heart attacks, heart failure and pneumonia. However, as a result of healthcare reform, treating such patients with these conditions may be "bundled" as a basis for prospective reimbursement over the course of an "episode of illness". These episodes may include both an original hospitalization and a TBD period for follow up treatment. This post-hospitalization period could include one or more readmissions (e.g. during a 90 day period). In that scenario, hospitals with higher readmission rates will fare much worse financially than those with lower rates. The bundled prospective payment they receive at the beginning of the period won't suffice to cover the expenses of one or more readmissions.
Analysis
Of course, to be fair to hospitals with higher readmission rates for patients with these and other conditions, payment policymakers must be prepared to take into account differences in pretreatment severities of illness of these patients and other factors (including socioeconomic status and even educational levels which may impact on post hospital treatment compliance rates). However, even when taking these factors into account, some hospitals still fare significantly better (or worse) than do others.
For all hospitals to do better and thereby fare better financially in an emerging world where decreasing readmissions will be key to obtaining more revenue, they must align themselves with leading organizations whose business it is to keep patients (regardless of their relative severities of illness, socioeconomic status and/or treatment compliance rates in the past) out of the hospital setting. Companies poised to accomplish this goal in partnership with hospitals include:
1. Healthways, Inc.;
2. Life Masters;
3. Alere;
4. Matria; and
5. Medco
